2004 Conference Proceedings

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DISTAL OUTCOMES OF STUDENTS WHO RECEIVED INTENSIVE AAC INTERVENTION AT BRIDGE SCHOOL

Presenter(s)
Mary Hunt-Berg, Ph. D., CCC-SLP
The Bridge School
1209 Howard Avenue Suite 200
Burlingame, CA 94010
Phone: (650) 343-4102
Email: mary@bridgeresearch.org

Christine Toomey, B. A.
The Bridge School
1209 Howard Avenue Suite 200
Burlingame, CA 94010
Phone: (650) 343-4102
Email: chris@bridgeresearch.org

Sarah Baroody, B. A.
The Bridge School
545 Eucalyptus Ave.
Hillsborough, CA 94010
Phone: (650) 696-7295
Email: sbaroody@bridgeschool.org

BACKGROUND

For a number of reasons, outcomes research in the area of assistive technology, including AAC, lags behind this type of research in other rehabilitation-related areas (1). The field of augmentative and alternative communication (AAC) urgently needs outcome data to ensure accountability, justify costs, and to strengthen our scientific foundation to inform clinical practice (e.g., 2).

For over fifteen years, the Bridge School, a nonprofit organization in the San Francisco Bay Area, has provided educational, AAC, and assistive technology services to school-aged children each having complex communication needs associated with severe speech and physical impairment. Bridge School is a full time transitional placement. Upon achievement of individual goals, students return to their respective local school district to continue their education with support from Bridge School's transition staff as needed.

A primary student-centered outcome targeted by Bridge School is the development of function, particularly in the area of communication. The Bridge School also aims to make positive impacts on less direct outcome domains including quality of life. Bridge School provides a range of unaided and aided intervention approaches to address the communication, education, and social participation needs of its students.

Over the years, former students and their families anecdotally have reported a range of long-term outcomes, both positive and negative. This presentation is based on a larger study looking at a range of long-term outcomes of former Bridge School students. These data will be used to inform Bridge School's educational practices, to increase accountability in future years, and to provide useful long-term outcome data for broader dissemination in the AAC field.

RESEARCH QUESTIONS

METHOD

Twenty-eight former Bridge School students and their families were invited to participate in the study. Of seventeen families who responded to the introductory letter, 16 consented to participate. Participants ranged in age from 9 to 25 years. All have complex communication needs associated with a diagnosis of cerebral palsy and severe speech and physical impairment. Student descriptive data and intervention variables of interest were summarized at three data points : first year and last year of enrollment at Bridge School, and then at follow-up using the following data collection methods:

1. Archival data review - Archival data sources include documents (student annual individual education plans, assessment reports, progress reports) and other records such as student work samples or overlays from communication devices. An electronic database was developed using Filemaker Pro to capture relevant variables from the clinical records for greater ease of examination. Selective data entry was conducted by trained professionals (one special educator and three speech language pathologists) each having over 5 years of experience working with students who use AAC in special education settings. Both student descriptive variables and Bridge School program variables were of interest for this study. Student descriptive variables that will be reported include diagnoses, developmental and skill levels reported, communication modalities and AAC technologies, selection techniques, representational strategies used and communication partners reported. Bridge program variables include the number of years each student attended Bridge, classroom description, communication goals, objectives, technologies, and types and levels of services provided.

2. Follow-up Interviews- A combination of interviews and measurement tools were selected and administered based on their sensitivity to the types of AAC outcomes targeted by Bridge School. Open-ended participant and family interviews gathered information regarding current educational and vocational placements and services received. Social Networks: A Communication Inventory for Individuals with Complex Communication Needs and their Communication Partners (3) was used to gather data regarding current participant skill profiles, communication modalities and technologies used, and communication partners. The Quality of Life Profile for People with Physical and Sensory Disabilities (4) was administered to measure quality of life across a number of domains.

RESULTS AND DISCUSSION

In presenting these data, we will include both group data and individual case examples to describe the intervention while at Bridge and the outcomes of research participants. Our follow-up data indicates that students continue to use a range of AAC technologies in interactions with some, but not all, partners in their respective current educational settings. For example, most students do not use AAC technologies with their most familiar communication partners, but often use AAC technologies for interactions in other situations. At time of follow-up, all participants report the use of facial expression/body language, gesture, vocalizations, and complex VOCA in their repertoire of expressive modes. However, in contrast to reported frequent use of facial expressions and gestures, the participants varied widely in their reported frequency, effectiveness, and efficiency of complex VOCA use. Analyses of the data reveal the changing nature of available assistive technologies and related goals and services over the 15-year period. Preliminary analyses also indicate positive levels of satisfaction with available assistive technology resources and services. A range of quality of life scores associated with positive perceptions by students and families will be discussed.

Clinical implications and future research directions will be discussed. We will describe how this study has informed and influenced the ongoing prospective longitudinal study of assistive technology outcomes also currently underway at the Bridge School. Because of the retrospective nature of this study, it was not possible to determine direct impacts of specific AAC technologies and services on various outcomes. Even so these data provide important insights in the areas of assistive technology use over time, functional communication, clinical status, satisfaction with the outcomes of services and perceived quality of life and self-determination of a group of individuals who participated for at least two years in an intensive educational program designed to optimize the use of AAC technologies to enhance communication and access to education.

REFERENCES

  1. DeRuyter, F. (1997). The importance of outcome measures for assistive technology service delivery systems. Technology and Disability, 6, 89-104.

  2. DeRuyter, F. & Jutai, J. (2002). Assistive Technology/AAC Outcomes. 2002 Interactive Webcast Series in AAC, Nathaniel H. Kornreich Technology Center, May 30, 2002.

  3. Blackstone, S. W. & Hunt-Berg, M. (2002). Social Networks: A Communication Inventory for Individuals with Complex Communication Needs and their Communication Partners. Monterey: Augmentative Communication, Inc.

  4. Renwick, R., Rudman, R., Raphael, D., Brown, I. (1998). Quality of Life Profile: People with Physical and Sensory Disabilities. Toronto, Canada: University of Toronto.


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